Several small studies of TNF-α antagonists in severe asthma have produced encouraging results which were not confirmed by later, large studies.
Tumor necrosis factor-alpha (TNF-alpha). Image source: Wikipedia, public domain.
A study of an antibody to TNF-α, golimumab, was conducted in 309 patients with severe asthma (Am J Respir Crit Care Med 2009;179:549-58).
Golimumab did not show improvement over placebo in FEV1 or severe exacerbations over the first 24 weeks of treatment. Treatment with golimumab was halted after a 24-week review, revealing not only no improvement but also an increase in infections and a nonsignificant increase in malignancies in those receiving golimumab.
Subgroup analyses suggested that there might be asthma phenotypes that would benefit from this treatment: those with lower FEV1, a 12% or greater bronchodilator response, a history of sinusitis, an emergency department visit or hospitalization in the previous year, or onset of asthma after age 12 years.
The authors suggested that TNF-α antagonism might still prove to be a viable option for selected phenotypes of severe asthma.
Cytokine-based treatments of asthma and allergic diseases.
News Beyond Our Pages. JACI, Volume 123, Issue 6, Pages 1197-1198 (June 2009).
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Cytokine-based treatments of asthma and allergic diseases